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there (more details in paragraph 5.2.4). At the same time there was a parallel flow of

medicines into Romania, for medicines no longer available on the Romanian market.

Health information and decision making

Decisions about health by the various governmental institutions are taken without much

linkage to the health needs of the population. In general decisions are not based on sound

information or analysis. Health outcomes could be improved within the constraints of the

limited budget by rational decision making. There is a centralised electronic information

system Sistemul Informatic Unic Integrat (SIUI) 9 that connects healthcare providers to the

CNAS. The system is far from perfect and is sometimes offline for several days. The system

needs a major overhaul, as it is hard to work with and requires many levels of authorisation

from the CNAS for approval of treatments. A lot of data is gathered but is not used and

analysed. Development of health economics systems could substantially improve the quality

of decision making. There are currently no mechanisms to measure the impact of health

actions or programmes. It is impossible to evaluate, if such programmes are actually working.

In the field of Health Technology Assessments HTA improvements can be made as well. The

HTA functions are assigned to the National Agency for Medicines and Medical Devices, but
are not yet fully implemented due to a lack of resources and expertise, as well as the unclear

delineation of functions.

Public health: prevention and screening

As seen in chapter 2, the main health risk factors in Romania are unhealthy eating (too much

animal fats, too little fruit and vegetables), alcohol consumption, smoking and little physical

exercise. This behaviour is on the one hand caused by socio-economic factors. The relatively

poor part of the population can’t afford healthy food, especially healthier meat products. On

the other hand there are cultural factors. It is a common thought that eating large volumes of

meat is good. To some extend there is also overcompensation from the communist times

when people experienced serious shortages in daily food articles. Nowadays there is an

abundance of food available, that is consumed somewhat too enthusiastically because it is

available. Romanian school pupils are hardly educated in healthy behaviour at school. At the

moment there are hardly campaigns to inform the public about healthy behaviour,

improvements can be made.

There are very limited screening campaigns. Most notably one for cervical cancer. However,

its result is limited, as women are not actively invited to participate. A preventive screen on

diabetes resulted in many more patients diagnosed with the disease, illustrating

underreporting in statistics and unmet health care needs.

9 The system is complex, next to SIUI there are also the related systems: SIPE (Sistemul Informatic de Prescripție

Electronică) and CEAS (Sistemul informatic al cardului electronic de asigurări de sănătate). It is outside the scope

of this report to go into more details, for more information: http://siui.casan.ro/cnas/despre_siui

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